Pregnant smokers chew on nicotine gum

Having given birth to four premature babies, Evelyn Rivera has experienced the problems that smoking during pregnancy can cause.

Now pregnant with her fifth child, Rivera has finally quit.

She credits a regimen of counseling and nicotine gum offered at a prenatal-care clinic as part of a national study aimed at making it easier for pregnant women to quit or at least reduce the number of cigarettes they smoke.

"Smoking is one of the most modifiable causes of poor pregnancy outcomes in the United States," said Dr. Cheryl Oncken, an internist and associate professor of medicine and obstetrics and gynecology at the University of Connecticut Health Center.

Oncken has been awarded a $1.6 million research grant from the National Institutes of Health to study whether nicotine gum can help pregnant smokers quit and, if they cannot, whether the gum can contribute to healthier births by helping expectant moms smoke less.

A heavy cost

Studies have found that smoking is responsible for 10 percent of infant deaths, doubles the risk of low birth weight and increases the risk of miscarriage by 30 to 50 percent.

Despite the risks, national statistics suggest that about 20 percent of pregnant women smoke, and the rate of those who quit during pregnancy is minuscule.

Oncken said she decided to try adding nicotine gum to conventional smoking-cessation counseling to see if it might help.

The U.S. Public Health Service has issued guidelines for quitting that call for a combination of counseling, social support and drugs such as nicotine-replacement products. Tobacco-dependence researchers have found that the drug-and-counseling combo is more effective than either approach alone.

But so far, pregnant women have been asked to go cold turkey because of concerns that nicotine-replacement products, such as gum or a patch, might be harmful to the fetus.

Oncken said she understands that concern. But the physician also noted that tobacco smoke contains 4,000 chemicals, including 69 cancer-causing agents.

Also, the smoke in the lungs can reduce the oxygen supply to a growing fetus.

She said researchers in Denmark who studied 250 pregnant smokers found that the group using a nicotine patch had significantly bigger babies than those without it, though the rate of quitting was not much higher in the nicotine patch group.

Oncken said she hopes her study will find that nicotine gum helps women quit smoking, but she also plans to measure birth weight to learn if smoking less during pregnancy can have some benefit.

Best to quit

"Quitting early is best," Oncken said. "But even women who quit later have beneficial effects because of the exponential growth later in pregnancy."

Evelyn Rivera participated in a testing phase of the study in which all participants were given nicotine gum. Now that the trial is under way, participants will not know whether they are chewing a nicotine-spiked gum or an inactive formula that tastes like nicotine gum.

Each woman also will participate in two individual counseling sessions in which therapists will help identify barriers to quitting and offer strategies for giving up cigarettes.

Factors that compel women to smoke through pregnancy include stress in their marriages or relationships and living in a household where other people smoke, said Ellen Dornelas, a psychologist and smoking-cessation researcher who is collaborating on the study.

Because low-income women are most likely to smoke during pregnancy, much of the recruiting is being done through Hartford Hospital's public prenatal clinic. But any pregnant woman who is over 16 and smokes at least five cigarettes a day is encouraged to join the study.

Rivera, a 34-year-old Hartford resident, said she decided to try to quit after reading about the study while waiting for her doctor. She said each of her first four children, now ages 8 to 18, was premature and spent time in the neonatal intensive care unit. Though all are healthy now, she remembers the heartache. "They're so small, you can't even hold them."

This time, she said, she took a stick of nicotine gum before her morning coffee. Her craving for a cigarette disappeared. In the past, she has tried to quit without medication but could not. She has not had a cigarette since July 8.

Rivera said she is looking forward to finding out if her baby, due New Year's Eve, will arrive on time and not four to eight weeks early, like her previous children.